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Sarah Baker
Family nurse practitioner Sarah Baker, 49, of Bismarck, N.D., works at the Northalnd Community Health Center in McClusky, N.D., thanks in large part to the National Health Service Corps program, which forgave her loans for training in exchange for service in the rural area.
Sarah Baker drives 130 miles round-trip every weekday from her home in Bismarck, N.D., to her job as the sole provider of primary health care in McClusky, N.D. -- population 500.
“I’m it,” says the 49-year-old family nurse practitioner, whose duties have ranged from an office visit for a 2-day-old newborn to a surgical session with a 75-year-old man who nearly lost an ear in a fall down an elevator shaft.
“I give them their flu shots, I give them their shingles shots,” she said. “I know I’ve kept some of them out of the hospital.”
Baker has held her position at the Northland Community Health Center for three years, thanks in large part to a growing federal program that will pay off some $34,000 in nursing school debt in exchange for her rural work.
She’s a member of the National Health Service Corps, which has more than tripled its numbers in the past three recession-stricken years, U.S. Health and Human Services department officials announced Thursday. The program helps would-be primary care doctors, nurses, dentists and other health care providers pay for training -- and repay medical debt -- in exchange for working in rural and medically under-served areas.
Since 2008, the number of NHSC members has climbed from about 3,600 providers serving some 3.7 million patients to more than 10,000 clinicians serving some 10.5 million patients, HHS officials reported.
“Thanks to the National Health Service Corps, more Americans can see a doctor and get the health care that they need,” said Health and Human Services Secretary Kathleen Sebelius.
At the same time, health professionals themselves have gotten a helping hand with the high costs of medical training.
That’s an important boost, especially for would-be primary care providers in a down economy, said Dr. Amy McIntyre, 29, who was a NHSC scholar while attending the Alpert Medical School at Brown University in Providence, R.I., and is now in her third year of residency at the Family Medicine Health Center in Boise, Idaho.
Students of all kinds, even medical students, have needed extra assistance with rising tuition. And the downturn has made it even more difficult for rural and under-served areas to attract health care providers to their clinics and hospitals, health experts say.
Next year, with NHSC help, McIntyre hopes to find her first job as a primary care doctor at a community health center in the rural Northwest.
She estimates the program paid for about $100,000 in medical school tuition, a huge boon in a country where the average med student graduates with median debt of about $160,000, according to the American Association of Medical Colleges.
The program essentially allows primary care doctors, who are paid less than specialists, to work in places that need them most, McIntyre said. In 2010, for instance, family care doctors were paid a median salary of $208,861, compared with a median salary of $402,000 for cardiologists and $500,672 for orthopedic surgeons, according to the American Medical Group Association.
Health workers in the program receive full salaries, but they're working in places that otherwise have a difficult time attracting primary care providers for a variety of reasons ranging from remote locations and scarce resources to very disadvantaged patients.
Idaho, for instance, where McIntyre works, ranks last in the U.S. with only 76 primary care doctors per 100,000 population, according to the United Health Foundation. That compares with Massachusetts, which has 191 primary care providers per 100,000 population.
“Programs like National Health Service Corps match dedicated primary care providers with communities in need, when otherwise forces in our health care system often drive providers away from our communities,” said McIntyre.
The program helps place health care providers at some 17,000 under-served and rural sites across the U.S. Though they’re free to leave after their required service is complete, some 82 percent of NHSC clinicians stay in the high-need areas where they start, HHS officials said.
This year’s NHSC program includes some 5,418 awards totaling $253 million for loan repayments through the Obama Administration’s Affordable Care Act, the American Recovery and Reinvestment Act and annual appropriations. About 62 percent of eligible applicants were accepted.
In addition, some 247 scholarship awards totaling $46 million were paid for through the Affordable Care Act. Only about 20 percent of eligible applicants were accepted.
Still, demand for the program is even higher. Applications have jumped 500 percent for the loan repayment program and 600 percent for the scholarship program since 2008, HHS officials said.
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Make 4 years of public service of underserved populations a requirement for federally guaranteed loans and we could go a long way toward doing away with that albatross of a health care bill.
In Cuba (education is free) every professional must serve 2 years at a lower salary in whatever place is available based on his own academic score. No loans to pay, but somehow you pay back to the state.
Although after that the regular salaries are still low compared to professionals in the US or even Latin America.
If the US and Europe didnt black list Cuba from doing business with them, or allowing travelers from our nations to theirs...Cuba would be doing quite well indeed.
Their communism isnt failing because it's communism, their country struggles because the two wealthiest regions of the world have blackballed them.
It's kinda hard to "compete" when you're not allowed to play, dont ya think?
Check your facts... the EU began lifting the embargo against cuba in 2005 to be completely removed by 2008 and latin america always gave you a hand. Go cry somewhere else.
Moreover, the staunchest supporters of the US embargo are your own fellow cubans living in the US. Matter of fact if it weren't for them there wouldn't be no embargo any more.
So if you *still* need the US to bail you out from your sorry mess I cannot but pity for you.
But what is the cost of living? Comparing salaries means nothing without that vital part of the puzzle.
For example, you earn less in North Dakota as compared to many other states, but you also pay significantly less for housing, among other things.
I grew up in a town of 7,000 in rural Montana, but I currently live near Atlanta and own a 3br/2bath 2200 sf home with 2car garage on 3/4 of an acre. For the same price, I would be in the market for a 2br/1bath home on 1/4 acre in my hometown. So contrary to what you might think, the cost of living in a small rural community isn't always less expensive. My folks pay the same for a gallon of milk and a loaf of bread that I do, and even though there's an oil refinery in my hometown, their gas prices are higher than mine and public transportation is almost nonexistant, so going without gassing up their car isn't an option.
The reality is that when you go to medical school, you incur lots of debt that will take you years to pay off. If you choose to practice in a rural community, it will likely pay less, but your cost of living won't be much different from someone living in a larger city in a nearby state (and in fact as in the case of my hometown, you might even be paying more). Same high college debt+less pay+high living costs=lower standard of living. Do the math and it's no wonder rural areas have a difficult time not only attracting, but also RETAINING physicians. So while I do agree that the cost of housing in Montana is much less than say, living in Seattle/LA/San Francisco/New York/Boston/DC, these cities are the extremes in terms of housing costs, not the norms in this country.
How do I know this? Personal experience - my dad is a physician in Montana.
I agree with having some kind of requirement or experience for docs, nurses, dentists when they receive their license for them to go out and provide long-needed services to individuals without access to consistent care.
Thank you, MSNBC for covering the NHSC and what great work is being done to keep our populations healthier!
I would like to make is a requirement for everyone to stay off welfare and unemployment for more that 2 years of their life. Fat chance of that happening.
why should I be REQUIRED to go someplace dictated to me by the government and FORCED to work somewhere for the sole reason that I have chosen a career in which I will be providing health services to people? why shouldn't the attorney, or the communications major, or the person with a degree in theater be FORCED to go give some years of his/her life working where some government agency dictates, in some designated 'high need' as punishment for THEIR career choice?
this isn't Communist Soviet Union, where the government selects your career and then dictates to you where and when you will work. someone who chooses to go into the healthcare field DOES NOT deserve to have their choices taken away from them, just because you think we should be required to do so. why don't YOU go off and serve the 'individuals without access to consistent care'? this article is about health workers being PAID to go to these areas-not forced. big difference
Allie - How about in return for the public funded guarantee of the loan that provided for your education? And personally I would like to see a public service requirement just to earn full citizenship, but I don't think that's ever going to happen.
Brian, I am not opposed to all young people doing public service- what I am opposed to is the suggestion that people going into health services be required to do so, while all other college majors are excluded. why should I have to sell my house, leave my family, and move to some rural area to serve the 'underserviced' just because I have chosen to be a nurse. sorry, but I have to point out that those people have CHOSEN to live where they live- why should my life be disrupted because of their choice? are/were YOU willing to go somewhere dictated by the government, to give service of whatever it is you do, when you graduated just because you chose to do something with your life other than take welfare or work at McDonald's? what service are all these art history and oral communication majors going to provide in exchange for THEIR 'public funding guarantees'?
this article is about a program where SOME health workers CHOOSE to participate in a program that trades them something for something; my reply was to a poster who thinks that ALL health services people should be forced to do something similar, solely because of our career choice. apparently you see no reason why this shouldn't be the rule; I happen to disagree. I think it should be obvious that forcing something like that on new graduates would result in a precipitous drop in people entering the health care field, leading to an even worse shortage of health care providers.
and by the way, my education is self-funded, just so you know. the public isn't guaranteeing my funding for anything. and while the government might guarantee funding while the student is in school, the note itself is carried and serviced by big banks- who charge a nice fee and interest rate, and who do so with the knowledge that nothing except death or repayment can cancel a student loan. so it's not like there is not profit being made on that money. the whole purpose of funding higher education was to produce educated higher-wage earners, which= taxpayers; the public funding guarantee was the way the government sweetened the pot to lure the big banks to come out and play. there is no need to make it sound like student loans are some kind of welfare system
Allie - perhaps you're misunderstanding what they said?
Jessica, my reply was to:
and
I think these two statements are perfectly clear, as were my replies directly to them. before one suggests 'what someone (else) should do, I think they should think through the implications of what they are suggesting. and I addressed this, because what was suggested 'they should do' would pertain directly to me
There's nothing wrong with living in a rural area. We're 20 min from a university town, have a local university center, excellent schools, library. None of the drive by shooting. Rare robbery/breakin. We can be in 2 urban areas in 1hr 15 minutes. Can see the stars at night and clear blue skies and mountains in the day time. I'm a healthcare professional and we need more MD's. The patients really prefer to receive care where they live and not be shipped out to the HUGE centers unless its absolutely necessary. Come work for ARH! Good benefits. Rural areas. NHSC debt forgiveness.
I love it when conservitives use every chance to talk about how bad the health care bill is.. It makes the fools who just watch the idiot box for thier opinions instead of actually reading legislations and forming thier own opinion easy to identify... Its not even a health care bill... it is insurance reform to protect consumers from immoral practices of insurance companies. The only reason it requires you to get insurance is because the goverment garentees if you need treatment you can't be turned away. Not having that penalty gives everyone free rain to drop thier coverage and get treatment on the governments tab. A better idea would be to have a public health care system like every other leading capitalist nations, with great health care statistics... But according to the idiot box fox lemmings... its the most socialist thing since bread lines... doesn't matter if it works for the rest of the world.
You're correct. It's actually a federally funded subsidy for health insurance companies.
Well, except that it doesn't, actually, work all that well for the rest of the world. At least not according to people who have to live with nationalized medical care. Some seem OK with it, but I've heard an awful lot of people in Canada say that they'd rather pay to see a doc in the U.S. than to go to a "free" doc in Canada. And, I'd say based on my experience with military and veterans health care that I'm not eager for the government to take over all health care. The insurance reforms could easily be taken care of by simply allowing insurance companies to compete across state lines. Of course, they don't like that idea, but who cares? Would you rather force something that makes sense down the throats of the insurance companies or something that doesn't make quite as much sense down the throats of the citizens?
Miker "The insurance reforms could easily be taken care of by simply allowing insurance companies to compete across state lines"
who's not allowing them?
Im a fan of single payer - what benefit does the insurance company actually provide?
They tell the hospital/doctors what they are willing to pay - single payer would be no different.
Insurance bases what they'll cover based off of what the govt says.
I'm ok with keeping insurance companies if we took the profit out of it - of course people who work their will still get paychecks, not profit doesnt mean = volunteer. It simply means CEO's and shareholders need not participate, need not make lots of money at the expense of peoples health.
My insurance provides tons of benefits, if you accept the numbers on the processed claims.
I don't totally accept those numbers as realistic. I believe they're grossly inflated, in fact, and I tend to agree with you that the "prices" are greatly influenced by the fact that insurance exists. However, contrary to your perspective, I tend to think insurance drives the price up simply because the hospitals gouge the insurers - not because the insurers dictate prices to the hospitals.
At any rate, apart from my premiums, I pay very little out of pocket for medical care, which would not be the case if I didn't have insurance. And, there's no way I'll be convinced that turning insurance companies into non-profits would IMPROVE their service. Have you done any business with a non-profit lately?
Yet all those other countries who have socialized medicine pay way higher taxes than we do here in the US. I prefer it this way, which is why I choose to live here in the US where I was born. Health Care should not be free, its a commodity just like when you go to the grocery store. You pay for your food, and you should pay for your health care. I got into the health care field back in the 80's because I knew or had the forethought to know it was one job area that would always be around. No matter where I went people would need health care. I also knew it paid well and would afford me a comfortable life. I expect to be paid for my services, for all the time I spent in school learning how to diagnose and prescribe medications. You get what you pay for, or if your a socialist you get what everybody else pays for you to have.
The work must be getting to her, article says she is 39..to me she looks early 50's.
Sorry, Mike277, tiny typo. Sarah is actually 49. It's fixed now. But, really? That's what you take away from story about a program that's helping meet the need for primary care in this country?
Well done JoNel, nit picking is ridiculous.
I guess someone finally watched old episodes of "Northern Exposure" - this makes sense.
Steve, did it occur to you that maybe Northern Exposure was based on these types of debt-forgiveness programs, which have been around for years?
My husband has been in Family Practice for 40 years and has never received a salary closeto $200,000. Only the Gov't can afford to pay that much (with our tax dollars!). He has worked in Penna, Massachusetts and currently in VT.
Dory-- stop with the gov't lies... the government doesn't pay that much and this article never said that... stick to facts or shut it.
Northern Exposure was based on this program. It was around long before the TV show. Just because the TV show gets more 'exposure' than this program...
Be nice if other professions had that. Like to get some student load debt taken care of too
Teachers can get several thousand dollars forgiven for five years of work in low income schools.
Some teachers also go to other countries and teach there as part of govt sponsored programs.
Thre are programs for other professions, although they may vary from state to state. Google the phrase "student loan repayment" or "student loan forgiveness" along with your state to see what may be available.
Dean of Yale Medical School: "That's right Dr. Lebowski. You can repay that $600,000 you owe us by accepting this government offer to practice ophthalmology in Bumphuc, Arkansas for only ten years after you finish your residency!
Maurice Minnifield: "That's right Dr. Fleischman. I'll repay your $600,000 student loans if you agree to practice family medicine in our town of Cicely, located on the cusp of the Alaskan Rivera, now that you have finished your residency!"
The National Health Service Corp has been around for a long time. I served in rural Alabama from 1986-1990. This was a life changing and somewhat of a career defining experience, both positively and negatively. I came out debt free (while average debt was not $160,000 when I finished medical school in 1983 it was still substantial) and felt I had served this nation in a positive way. I also had a chance to see how impersonal the NHSC could be, both to the physicians and, more importantly, to the people being served. Retention after completing your tour was not a priority. This was a shame and I hope the NHSC now pays more attention to identifying and nurturing candidates through college, medical school and residency training and then returning them to their home community where they have family and social supports. Taking a Connecticut Yankee and plunking him down in rural Alabama was not a recipe for retention. Personally, I am glad to see the NHSC enjoying a resurgence. The program has the potential benefits both the patients in under served areas and the next generation of physicians, dentists, nurses, PAs and NPs. While not right for everyone, the NHSC can launch the careers of some very promising young physicians and guide them to make a difference.
NHSC does pay more attention to clinician support and retention than they used to. You can check out the changes on their website. You can also help in that area by being an NHSC Ambassador an mentoring NHSC clinicians if you want.
I have the privilege of regularly working with medical students as well as residents. I frequently tell them stories of my experiences - both good (house calls, riding with paramedics, very positive outcomes) and bad (such as an internist being left alone in town and expected to deliver babies - never a good idea) experiences. When I have spoken with local NHSC advocates I have been told to emphasize the good and downplay that which might not be seen as positive. I am a big believer in presenting the whole story as the NHSC is not for everyone and you have to enter that experience with very open eyes. So I'll stay away from ambassadorship and stick with my limited audience.
Just another bureacratic program that should not exist. Just keep justifying program after program.........sorry, it is not a good plan.
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This program sounds great. Where I live in the northeast I work a boatload of hours make $70,000 a year as an FP physician. Which means I will pay off my $300,000 med school debt in........................never. NP's and PA's make much more than docs around here are much more in demand. Specialization is the way to go in medicine. I have classmates in cards, ortho and derm making $400,000, $500,000 plus a year already with all of their loans paid off in 3 years.
Sounds like you need to join a better practice. Most the the FP's around here make 225k to 300k ....THe NP's and PA's around 80k...Not a helleva lot comparatively. I am not a big believer in the medical system. Doctors should have all their schooling paid and when they get to the private sector should be capped at a 100k because most of medical system is government funded through medicare, ma or cost shifted to the payers through higher rates for workers.
Have you looked into NHSC? The website is
It's having problems with posting the website
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The NHSC also assigns people to underserved urban clinics. I did my loan repayment in an inner city STD/HIV clinic. I figured I could do anything for 2 years to get my loans paid off. And, yes, I make less than I could in a private practice or a hospital, but as it turned out, I like what I do & feel like I'm making a difference. So I'm still there 16 years later. Thank you National Health Service Corps.
Thanks Eve.
The NHSC gets far less credit, publicity, and funding than it deserves.
Thank you for serving the underserved.
I'm far from liberal, and this program I totally agree with.
NHSC provides student loan repayment assistance for more than just docs and nurses. You can find a full list of eligible health profession disciplines and specialties on the NHSC website at
NHSC and other loan repayments cannot be demonstrated to actually result in what is most needed - more primary care. Such incentives merely rearrange the deck chairs moving workforce from where they would have located (a practice site in need of workforce) to one slightly more in need. This is because the US actually has 30,000 zip codes with 65% of the US population that have lower to lowest concentrations of primary care and health workforce. Loan repayments work for family practice MD, DO, NP, and PA because family practice is the only specialty to be found with over 50% serving the 30,000 zip codes with 65% of the US population. Other sources are 25% or less found in needed locations. Loan repayment is nice for family practice types, but fails the US as an efficient or effective solution.
Alaska is a primary example of what is facing over 30 other states left behind in workforce. Alaska spends 1 million more each year for locums, recruitment, and retention costs to attempt to keep up with primary care losses. The US is actually adding about 200 - 400 million more a year nationwide to such costs without adding any primary care workforce. Each primary care source is actually declining to lower proportions steadily with each passing year.
HRSA is far too little and too late to overcome a US Design that sends 50% of workforce and well over 50% of health spending to 1% of the land area or 1000 zip codes with top concentrations at over 200 physicians each. Manhattan zip codes are a prime example. Until the US has a design focused on people needs instead health insurance, academic, hospital, subspecialty, non-primary care, research, stockholder, and medical education interests - the US will fail in health access and HRSA programs and reports will only distract from real solutions.
Well intentioned is no longer good enough. The US must have RN, MD, DO, NP, and PA that are specifically trained in primary care and that remain entire careers in broadest scope generalist primary care. None are specifically trained and few actually choose and remain primary care. If the US had a real design for health access, family medicine would be at 8000 to 11000 annual graduates per year, not the same 3000 a year in annual graduates first reached in 1980. If the US had a real primary care design, the 270,000 primary care nurses would be the most important primary care workforce instead of being forced to hassle with insurance or government cost cutting designs (the opposite of designs for health) to get even the most basic care for their patients.
Innovation and reorganization are just talk without the experienced, dedicated, continuity, permanent primary care workforce to deliver on so many promises by those who know so little about primary care or Basic Health Access. What works? Permanent Primary Care, Universal health care coverage for primary care and public health, and revenue for primary care that exceeds the increasing cost of delivering primary care are SMART designs - Specific, Measurable, Achievable, Realistic, and Timely - and necessary for any hope of a future health system at all.